Geriatric Home-Based Medical Care by Jennifer L. Hayashi & Bruce Leff

Author:Jennifer L. Hayashi & Bruce Leff
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

8.3.3 Treatment

Improvement in continence is possible for many patients, including those with cognitive and/or physical impairments and multiple comorbidities. Before embarking on a potentially time-consuming or expensive treatment plan, first consider if discontinuing or reducing an existing medication or changing the home environment for ease of navigation may help. Other treatment choices include behavioral therapy, medications, and invasive treatments including surgery. In many cases, behavioral and pharmacological therapies can be combined for optimal management. Consider the patient’s comorbidities, functional and cognitive impairments, goals of care, polypharmacy, and susceptibility to adverse effects [24, 25].

While little is known about outcomes of surgical treatment of UI in frail elderly patients, perhaps reflecting a bias toward conservative therapy in patients with multiple impairments, age alone should not be a contraindication for surgical or invasive treatment [24, 30]. For women with stress UI who fail behavioral therapies such as pelvic floor muscle training as described below, one surgical option is a suburethral sling. However, homebound patients may have significant comorbidities or may be unwilling to undergo surgery. These women may benefit from a less invasive procedure done in an office or surgical setting in which bulking agents such as collagen are injected periurethrally, a method which has been found to improve incontinence in some elderly women with stress UI or mixed UI [40]. For some patients in whom improved continence is either unachievable or not priority in the goals of care, the best strategy may be management of incontinence to prevent skin breakdown, maintain quality of life, and relieve caregiver burden [24].

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